UTA NURS 3261 Older Adults Exam 2
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| Restraint risks | hyperthermia, new-onset bowel and bladder incontinence, constipation, decreased appetite, pressure ulcers, muscle weakness, injury to nerves and joints, or increased risk of nosocomial infections, such as pneumonia and respiratory complications.
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| Percent of care provided by families in the US | 80 percent
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| Profile of the average, informal caregiver in the US | 46 years old, female, holds a full-time job and spends an average of 18 hours a week caring for her mom who lives nearby.
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| Stages of caregiver burnout | 1. Frustration, 2. Isolation, 3. Despair
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| Syptoms of caregiver burnout | changes in eating patterns, losing or gaining weight, irritability, impatience, and the inability to multitask.
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| Physical abuse | acts of violence that may result in pain or injury, includes sexual
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| Signs of abuse | unexplained fractures, welts, burns, ligature marks, unexplained STDs
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| Physical neglect | withholding food, water, medications, hygiene, or other goods or services that are necessary for optimal functioning.
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| Psychological or emotional abuse | diminishes the identity, dignity, and self worth of the person
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| Financial or material abuse | when the older person’s money or property is used for financial gain by the caregiver
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| The Social Security Act of 1935 was designed to | prevent destitution among the elderly and dependency on younger workers.
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| Part A pays for | hospitalization, home health, hospice and some skilled nursing care.
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| Medicare Part B pays for | office visits and outpatient services as well as other things.
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| Medicare Part D pays for | prescription drugs
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| Medicaid helps pay for | medications, Medicare premiums and copays, custodial care in nursing homes, as well as certain in-home services through CBA - Community-Based Alternative Care.
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| Death-defying societies | refuse to believe that death would take anything away and believe it could be overcome.
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| Death-accepting societies | view death as an inevitable and natural part of the life cycle.
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| And death-denying societies | refuse to confront death, believe that death is the opposite of living and that it’s not a natural part of human existence.
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| Three leading causes of death in adult Americans | cardiovascular disease, cancer, and cerebrovascular disease
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| Medicare Hospice benefits pay for | for medications related to the terminal condition, nursing care, medical supervision, and medical equipment needed to treat the terminal condition.
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| Drugs that increase risk for falls | antiepileptics, benzodiazepines
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| Polypharmacy | Five or more drugs
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| Of all available nonsteroidal anti-inflammatory drugs, this drug produces the most CNS adverse effects | Indomethacin (Indocin and Indocin SR)
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| Narcotic analgesic that causes more CNS adverse effects, including confusion and hallucinations, more commonly than other narcotic drugs. Additionally, it is a mixed agonist and antagonist. | Pentazocine (Talwin)
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| One of the least effective antiemetic drugs, yet it can cause extrapyramidal adverse effects. | Trimethobenzamide (Tigan)
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| Most of these drugs are poorly tolerated by elderly patients, since these cause anticholinergic adverse effects, sedation, and weakness. Additionally, their effectiveness at doses tolerated by elderly patients is questionable. | Muscle relaxants and antispasmodics: methocarbamol (Robaxin), carisoprodol (Soma), chlorzoxazone (Paraflex),metaxalone (Skelaxin), cyclobenzaprine (Flexeril), and oxybutynin (Ditropan). Do not consider the extended-release Ditropan XL.
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| This benzodiazepine hypnotic has an extremely long half-life in elderly patients (often days), producing prolonged sedation and increasing the incidence of falls and fracture. Mediumor short-acting benzodiazepines are preferable. | Flurazepam (Dalmane)
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| Because of its strong anticholinergic and sedation properties, this is rarely the antidepressant of choice for elderly patients. | Amitriptyline (Elavil), chlordiazepoxide-amitriptyline (Limbitrol), and perphenazine-amitriptyline (Triavil)
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| Because of its strong anticholinergic and sedating properties, this is rarely the antidepressant of choice for elderly patients. | Doxepin (Sinequan)
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| This is a highly addictive and sedating anxiolytic. Those using it for prolonged periods may become addicted and may need to be withdrawn slowly. | Meprobamate (Miltown and Equanil)
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| These drugs have a long half-life in elderly patients (often several days), producing prolonged sedation and increasing the risk of falls and fractures. | Long-acting benzodiazepines: chlordiazepoxide (Librium), chlordiazepoxide-amitriptyline (Limbitrol) clidinium-chlordiazepoxide (Librax), diazepam (Valium), quazepam (Doral), halazepam (Paxipam), and chlorazepate (Tranxene)
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| Of all antiarrhythmic drugs, this is the most potent negative inotrope and therefore may induce heart failure in elderly patients. It is also strongly anticholinergic. Other antiarrhythmic drugs should be used. | Disopyramide (Norpace and Norpace CR)
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| May cause bradycardia and exacerbate depression in elderly patients. | Methyldopa (Aldomet) and methyldopa-hydrochlorothiazide (Aldoril)
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| May induce depression, impotence, sedation, and orthostatic hypotension. | Reserpine at doses >0.25 mg
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| It has a prolonged half-life in elderly patients and could cause prolonged hypoglycemia. Additionally, it is the only oral hypoglycemic agent that causes SIADH. | Chlorpropamide (Diabinese)
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| Drugs are highly anticholinergic and have uncertain effectiveness. These drugs should be avoided (especially for long-term use). | Gastrointestinal antispasmodic drugs: dicyclomine (Bentyl), hyoscyamine (Levsin and Levsinex), propantheline (Pro-Banthine), belladonna alkaloids (Donnatal and others), and clidinium-chlordiazepoxide (Librax)
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| May have potent anticholinergic properties. | Anticholinergics and antihistamines: chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), hydroxyzine (Vistaril and Atarax), cyproheptadine (Periactin), promethazine (Phenergan), tripelennamine, dexchlorpheniramine (Polaramine)
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| May cause confusion and sedation. Should not be used as a hypnotic, and when used to treat emergency allergic reactions, it should be used in the smallest possible dose. | Diphenhydramine (Benadryl)
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| Have not been shown to be effective in the doses studied. | Ergot mesyloids (Hydergine) and cyclandelate (Cyclospasmol)
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| Doses >325 mg/d do not dramatically increase the amount absorbed but greatly increase the incidence of constipation. | Ferrous sulfate >325 mg/d
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| Are highly addictive and cause more adverse effects than most sedative or hypnotic drugs in elderly patients. | All barbiturates (except phenobarbital) except when used to control seizures
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| Not an effective oral analgesic in doses commonly used. May cause confusion and has many disadvantages to other narcotic drugs. | Meperidine (Demerol)
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| Has been shown to be no better than aspirin in preventing clotting and may be considerably more toxic. Safer, more effective alternatives exist. | Ticlopidine (Ticlid)
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| Immediate and long-term use should be avoided in older persons, since a significant number have asymptomatic GI pathologic conditions. | Ketorolac (Toradol)
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| These drugs have potential for causing dependence, hypertension, angina, and myocardial infarction. | Amphetamines and anorexic agents
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| Have the potential to produce GI bleeding, renal failure, high blood pressure, and heart failure. | Long-term use of full-dosage, longer half-life, non–COX-selective NSAIDs: naproxen (Naprosyn, Avaprox, and Aleve), oxaprozin (Daypro), and piroxicam (Feldene)
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| Long half-life of drug and risk of producing excessive CNS stimulation, sleep disturbances, and increasing agitation. Safer alternatives exist. | Daily fluoxetine (Prozac)
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| May exacerbate bowel dysfunction. | Long-term use of stimulant laxatives: bisacodyl (Dulcolax), cascara sagrada, and Neoloid except in the presence of opiate analgesic use
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| Associated with QT interval problems and risk of provoking torsades de pointes. Lack of efficacy in older adults. | Amiodarone (Cordarone)
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| Causes more sedation and anticholinergic adverse effects than safer alternatives. | Orphenadrine (Norflex)
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| May cause orthostatic hypotension. | Guanethidine (Ismelin), Guanadrel (Hylorel)
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| Potential for renal impairment. Safer alternatives available. | Nitrofurantoin (Macrodantin)
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| Potential for hypotension, dry mouth, and urinary problems. | Doxazosin (Cardura)
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| Potential for prostatic hypertrophy and cardiac problems. | Methyltestosterone (Android, Virilon, and Testrad)
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| Greater potential for CNS and extrapyramidal adverse effects. | Thioridazine (Mellaril), Mesoridazine (Serentil)
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| Potential for hypotension and constipation. | Short acting nifedipine (Procardia and Adalat)
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| Potential for orthostatic hypotension and CNS adverse effects. | Clonidine (Catapres)
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| Potential for aspiration and adverse effects. Safer alternatives available. | Mineral oil
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| CNS adverse effects including confusion. | Cimetidine (Tagamet)
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| Potential for hypertension and fluid imbalances. Safer alternatives available. | Ethacrynic acid (Edecrin)
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| Concerns about cardiac effects. Safer alternatives available. | Desiccated thyroid
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| CNS stimulant adverse effects. | Amphetamines (excluding methylphenidate hydrochloride and anorexics)
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| Evidence of the carcinogenic (breast and endometrial cancer) potential of these agents and lack of cardioprotective effect in older women. | Estrogens only (oral)
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| Four issues affecting the health of older persons | lack of resources; scarcity of providers; financial barriers; and cultural barriers and biases
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